Prevention and management of febrile seizures

Pediatric epilepsy and first afebrile seizure in Singapore: epidemiology and investigation yield at presentation

The authors studied pediatric epilepsy and first afebrile seizure at presentation in Singapore. A total of 211 participants aged 1 month to 15 years with first presentation for afebrile seizures were recruited from November 2002 to May 2004; 108 with ≥2 prior afebrile seizures (newly diagnosed epilepsy) and 103 with first afebrile seizures. A χ(2) analysis of demographics, risk factors, examination, and investigation findings showed significant differences in development (normal in 87% [newly diagnosed epilepsy] and 93% [first afebrile seizure], P = .046), neurological examination (normal in 92% [newly diagnosed epilepsy] and 98% [first afebrile seizure], P = .016), and electroencephalogram findings (abnormal in 75% [newly diagnosed epilepsy] and 36.9% [first afebrile seizure], P < .005). Pediatric epilepsy incidence at our institution is 24 per 100 000 person-years and is highest in early childhood. Focal epilepsy is more common than generalized epilepsy. Patients with first afebrile seizure and abnormal development, neurological examination, and electroencephalogram findings should be monitored for future development of epilepsy. Population-based studies are recommended.

Improving paediatric nurses' knowledge and attitudes in childhood fever management

AIM

This paper reports an evaluation of the effectiveness of a peer education programme in developing paediatric nurses' evidence-based knowledge and attitudes towards fever management and the sustainability of these changes.

BACKGROUND

In general, paediatric nurses' fever management knowledge seems to be mediocre. They believe fever to be harmful, causing febrile convulsions and brain damage. Antipyretics are administered to prevent febrile convulsions and alternate antipyretics are given when temperatures are not reduced.

METHOD

A quasi-experiment was conducted from August 2002 to March 2003. An experimental group of Registered Nurses received the peer education programme and peer support and education were promoted for those unable to attend the sessions. A control group continued its normal practices. Seventy-seven nurses were eligible to attend the programme; 74.0% attended at least one session, 52% two or more. Questionnaire data were collected 1 month before and 1 and 4 months after the peer education programme from 56.3% to 77.8% of eligible experimental and 40.9% to 51.6% of eligible control group nurses.

FINDINGS

Interaction effects between group and time were found in overall knowledge (P = 0.01), specifically knowledge of the physiology of fever (P = 0.001), and attitudes towards evidence-based fever management (P = 0.05). In addition, experimental group nurses demonstrated statistically significantly more knowledge of general fever management principles at 4 months after the intervention than control group nurses (P = 0.01), and compared with their own knowledge at baseline (P < 0.001).

CONCLUSIONS

Educational programmes targeting practice change must be theoretically based and target knowledge, attitudes and barriers to change. The programme tested here, which incorporated peer education and support and facilitated group change, is adaptable to other practices, groups and settings.

Genome-wide analysis of phenobarbital-inducible genes in Drosophila melanogaster

An oligoarray analysis was conducted to determine the differential expression of genes due to phenobarbital exposure in Drosophila melanogaster (w(1118) strain) third instar larvae. Seventeen genes were observed to be induced with increased expression by a statistical analysis of microarrays approach with a q < or = 0.05. At q < or = 0.12, four more genes (Cyp12d1, DmGstd4, and two genes with unknown function) were found to be up-regulated, and 11 genes with unknown function were found to be down-regulated. Fifteen of these genes, Cyp4d14, Cyp6a2, Cyp6a8, Cyp12d1, Cyp6d5, Cyp6w1, CG2065, DmGstd6, DmGstd7, Amy-p/Amy-d, Ugt86Dd, GC5724, Jheh1, Jheh2 and CG11893, were verified using quantitative real time polymerase chain reaction. Some of these genes have been shown to be over-transcribed in metabolically DDT-resistant Drosophila strains.

Paediatric fever management: continuing education for clinical nurses

PURPOSE

This study examined the influence of level of practice, additional paediatric education and length of paediatric and current experience on nurses' knowledge of and beliefs about fever and fever management.

METHOD

Fifty-one nurses from medical wards in an Australian metropolitan paediatric hospital completed a self-report descriptive survey.

RESULTS

Knowledge of fever management was mediocre (Mean 12.4, SD 2.18 on 20 items). Nurses practicing at a higher level and those with between one and four years paediatric or current experience were more knowledgeable than novices or more experienced nurses. Negative beliefs that would impact nursing practice were identified. Interestingly, beliefs about fever, antipyretic use in fever management and febrile seizures were similar; they were not influenced by nurses' knowledge, experience, education or level of practice.

CONCLUSIONS

Paediatric nurses are not expert fever managers. Knowledge deficits and negative attitudes influence their practice irrespective of additional paediatric education, paediatric or current experience or level of practice. Continuing education is therefore needed for all paediatric nurses to ensure the latest clear evidence available in the literature for best practice in fever management is applied.

Fever management: paediatric nurses' knowledge, attitudes and influencing factors

AIMS

This paper describes Australian paediatric nurses' knowledge of and attitudes toward fever and its management and the predictors of their intentions to administer paracetamol to a febrile child.

BACKGROUND

Despite evidence-based support for the beneficial effects of fever over the past three decades, health professionals' negative attitudes toward fever and their reliance on antipyretics to reduce it have persisted and continue to be reported in the literature.

METHODS

A self-report questionnaire was used. An instrument was developed, piloted by test-retest and revised prior to data collection. Fifty-one paediatric nurses working in medical wards of a metropolitan paediatric hospital in Australia participated.

RESULTS

Nurses' mean knowledge score about the physiology of fever, general fever management and antipyretics was 62%, which was not as high as expected. Participants reported positive attitudes toward the benefits of fever, the necessity for its reduction in children with pre-existing cardiac or respiratory conditions and towards regular antipyretic administration masking the infective process. Negative attitudes included disbelief that temperature is often unrelated to illness severity. Conflicting attitudes toward febrile convulsions were highlighted by beliefs that antipyretic therapy prevents these and that antipyretics do not prevent initial febrile convulsions. Predictors of intentions to administer paracetamol were beliefs about the effectiveness of paracetamol and nurses' beliefs about the expectations of others in relation to paracetamol administration. Nurses reported strong intentions to administer paracetamol to the next febrile child they cared for. Limitations of the study include the use of a nurse manager for recruitment and collecting the data at only one site.

CONCLUSIONS

Fever management is an integral aspect of paediatric nursing. For its consistent rational management, nurses must have appropriate knowledge and positive attitudes. This highlights the need for continuing education in fever management.

Overtreatment in children with epilepsy

Children with epilepsy are at risk for overtreatment, defined as the use of an excessive number or amount of antiepiletic drugs (AEDs). While the extent of overtreatment of epilepsy in children is not known, there is increasing awareness that overtreatment with AEDs contributes to the morbidity associated with childhood epilepsy. Reasons for overtreatment include using AEDs in a child with seizures who does not require therapy, choosing an inappropriate AED for the seizure type or syndrome; treating non-epileptic behaviors as seizures, use of polytherapy when monotherapy would suffice, and inadequate therapeutic options. Despite the introduction of eight new AEDs in the United States during the last decade, many children continue to be treated with the older generation sedative AEDs. Numerous investigators have now demonstrated that sedative AEDs can be safely removed from the drug regimen of children with epilepsy with resultant improvement in behavior, alertness, and improved seizure control. However, the biggest obstacle to overtreatment is the lack of effective therapies for many of the childhood epileptic syndromes. Until there are more effective therapies developed it is highly likely that children will continue to be over-medicated on ineffective and detrimental AEDs.